A study released by marketing information services company J.D. Power in Troy indicates that despite an industry-wide transition to value-based payment models that incentivize preventive care and active communication between health plans and members, commercial health plans are missing the mark when it comes to patient engagement.
J.D. Power’s 2023 U.S. Commercial Member Health Plan Study states customer satisfaction with commercial health plans is particularly strained among members of Gen Y and Gen Z, driven largely by poor customer service and communication scores.
Health Alliance Plan of Michigan in Detroit had a satisfaction score of 735, putting it in the top third of health plans cited by J.D. Power in its list of the top plans surveyed.
Similarly, members with the lowest self-reported health status are most likely to experience communications challenges with their health plans, according to J.D. Power.
“The transition to value-based care is predicated on the idea that payors and providers can drive better outcomes at a lower cost by improving patient engagement, yet many commercial health plans are having challenges getting the right information and support to patients when and where they need it,” says Christopher Lis, managing director of global health care intelligence for J.D. Power.
“Moreover, in patients with self-reported health status of ‘poor and fair,’ only 17 percent were assigned to a case manager. Yet for these patients with oftentimes complex health conditions, seeing multiple providers and taking several prescriptions, care fragmentation leads to poor health outcomes and higher spending in the very population that needs coordinated care the most.”
Following are some key findings of the 2023 study:
- Overall satisfaction declines year over year: Overall satisfaction falls 13 points (on a 1,000-point scale) this year, driven largely by a 33-point decline in satisfaction with customer service. Coverage and benefits (-20 points); provider choice (-16); and information and communication (-16) also decline significantly.
- Net Promoter Score (NPS) for new members is poor, highlighting the importance of onboarding: The average NPS score for new members is 6 (on a scale of -100 to 100), whereas the average score for established plan members is 25. This significant difference suggests that new members are not receiving clear information and support on how to navigate their healthcare benefits.
- Sicker patients are less likely to receive proactive care coordination: Among patients with a self-reported health status of “poor/fair,” 36 percent say their health plan helped them coordinate care. Among patients with a self-reported health status of “very good/excellent,” 43 percent say their health plan helped to coordinate care.
- Despite investment in digital health tools, health plan member usage remains low: Digital usage for all tools and support remains below 50 percent. Even among the sickest patients, use of online health assessments is 18 percent; use of chronic disease management tools is 8 percent; use of online triage and nursing support is 10 percent; and remote monitoring 6 percent.
The U.S. Commercial Member Health Plan Study, now in its 17th year, measures satisfaction among members of 147 health plans in 22 regions throughout the United States by examining six factors (in alphabetical order): billing and payment; cost; coverage and benefits; customer service; information and communication; and provider choice.
The study is based on responses from 32,656 commercial health plan members and was fielded from January through April 2023.
